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Home My WebLink Aboutbld-23-002687 i pa it/Zzz2 ei- ' ake I ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department .............. of y 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish `_: a One-or Two-FamilyDwelling a E D S ; -- - E V This Section For Official Use Only Building Permit Number: i J ..2 — DOA('Vi Date Applied: NOV 14 1Q12 r11"\ CA`S `l,.. ......„1.,, BUILDING DEPARTMENT 1Qy:_ Building Official(Print Name) Signature a e ` SECTION 1:SITE INFORMATION /1.1 Property Address: 3of1.+Y1 1.2 Assessors Map&Parcel Numbers 1/ Cl MAY F41/LK go. YirrAea tpda2r-mo 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: Outside Flood Zone? _ Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` 2.1 Owner'of Record: Ft.T -M4rr(LA - rrieb/Ir MA 6247E tic Name(Print) City,State,ZIP pan ,bt,W Tyi_,,E 2 SI •14er G44,44 2/9 Sa✓77i 41 7-6tic-5142 + #E O-44s1L. cu4 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ,&J4W-« ext Srl,/. /)d J&k vji— (,✓14$.440,4 d J S i j C&ALir tto'✓fe A{-r-Atic Ltc1Af1 tevr,t tdt77', j CI trot(ex_ ( vrrt-r 7) 7D Pefl c tr- D 12(JeziI( LLVC L 0.07(1 •f i f Ale -/K '44'o'4 . I A)Cr/-LI. S,.vt.41.1._ r41 A.r/6-ut.t/L /ftchu oar O vevc ht=,-Aoo•[. S(ph..ro-A4 S K/y&t a5 StA(c(..%t vL ra kCi.tom;. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee:$\CO Indicate how fee is determined: 2.Electrical $ Ql Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ —�' 4.Mechanical (HVAC) $ List: 0 l 5.Mechanical (Fire �i Suppression) $ Total All Fees:$ - �' Check No. Check Amount: Cash ount: 7 6.Total Project Cost: $ / — ❑Paid in Full1\ G ,f' !�Outstanding Balance e: I\\d")'\ )- SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu. ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date No.and Street Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 0 No .0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date • SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. PP 7-i II '22 Print 0 Ag ent's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.2ov/oca Information on the Construction Supervisor License can be found at www.mass.2ov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) , Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 ' Boston, MA 02114-2017 \twim. SY.�'� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): PE L-r_ AA AT 1 I LA Address: c l I2A1 FArtA1 aoto City/State/Zip: 7if/Z (O Tl(Pe r A4A G26 is Phone #: (,i 7- (o4S- 5g62 Are you an employer?Check the appropriate box: Type of project(required): 1.111I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0I am a homeowner doing all work myself.[No workers'comp. insurance required.]t 10 0 Building addition 4.1glI am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp. insurance.: 14.IE Other /2�°C4ci J6-- i,;;;,ipcc; 6.0We are a corporation and its officers have exercised their right of exemption per MGL c. 1 t)ceZ 152,§I(4),and we have no employees.[No workers'comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the p 'ns and penalties of perjury that the information provided above is true and correct. Signature: . Date: i t fi'f f 7 Phone#: C't 7 -6. Li -C-3‘.9 Z Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF YARMOUTH oA BUILDING DEPARTMENT MATTAC EysL_ <l 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DA'1'h: JOB LOCATION: AAk rLA 514Gl1 SKM" S. 7'6U442`iircc/kii - NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" Pe-mt.AM-rrrLA Co(7-60y>- S3G2 NAME HOME PHONE WORK PHONE PRESENT MAfLNG ADDRESS Sit rl-5 4- 1 E Sl igAtef tiK.t rZQ Sc rr- `IA✓( ra ootiet - , 1 d Z607S CITY OR TOWN STA'1'h ZIP CODE The current exemption for `Homeowner' was extended to include owner-occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall submit to the building official, on a form acceptable to the building official,that he/she shall be responsible for all such work performed under the building. permit. (Section 110 R5.1.3.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yeas No If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexemp TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 ✓ 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G. L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5 I hereby certify that the debris resulting from the proposed work/demolition to be conducted at S( A.2A1 .e44-4.4 4r, S),/rif lttvu2� Work Address Is to be disposed of at the following location: `14' r-A-' 1-1M Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. i �' /lilaZ Signature of Applicant Date Permit No. / 1' , °q TOWN OF YARMOUTH ° 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 r V-A. -. Telephone(508) 398-2231 Ext. 1292-Fax(508)398-0836 OCT 2 6 ZOZZ OLD KING'S HIGHWAY HISTORIC DISTRICT COM rcrge, EIVED 1 t h iw U i APPLICATION FOR I OLD Kit ` �II_aFi1N ' _ CERTIFICATE OF EXEMPTION OCT 27 2022 Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 nt, ,'8Pe rit' �` #Ei� NT Acts of 1973, as amended, for the proposed work as described below and on plans, dra Y — • •• accompanying this application. Type or print legibly: Address of proposed work. C( 13'A'FARM RD C-, 1 "'(Tiro ftr r M ii Map/Lot# 1 J 112- Owners): pG(t1L A-1J 6 Lre A1J MA r r i C A Phone#: 61 7-{4'45- 5 3 6 - All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: 3 f MAI FA-it:tk (ZD. 5. `4-kw,: faker AAA 024-/s Year built: i`I -7 Email S�� Mra' rt t r1 C,vt,�it_. cc,Al Preferred notification method. Phone V Email Aoent/Contractor: I Cii t`Lt�S a rJ t��2 yt,}q tL Phone#: ` 6 -4128-39 ee Mailing Address: 11 Ci Mt1(.+4' Ar r.1 .4 s fi r2d,4O ,M 12 TO,JS lvt t tt.c., AAA 024,148 Email Preferred notification method: ✓ Phone Email Description of Proposed Work(Additional pages may be attached if necessary): O REpt.ACe: 'CM sT-f,u6.. Nu&LL 1'tvi1G <4lilOdW (. )1 itth„S(_ 5-16 . CAAty. 4T... Dflt U'I:ih.iA 1 L- V(:t_ tm trfrt L-"xrolt d it. Dcie 1'c, ( i Ltoil-I rt&TLG-L4s.$) TLf (1E}2mt.T CVta..76. ;Al t--t VCL E:-14 z -1 T ) Fr 14(S i h 5 Alcc 1 t,.{ . 4 .-r.r°r- 'TZ) Sc nAi 4 s A m..j or '.t, . e tNST-'Ait(COINJSr(Lo .r .S4t4t.L tro.%t4i3i(r(Aic L Ric Wog.•A JirvG- LittC vs''E-ccr_ust5,n ..rr~ cut rat (;,,fit s'nx..1(r (At.i.frNA-FknthLVciir36t.,&c. Signed(Owner or agent). Date. 7cf 1 e Z- ' Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments.also) ➢ This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later, For Committee use only: Date. !j?I/z1 /Approved Approved with changes --- - -----Denied- .--.. Amount 20 r tO Reason for denial. OWED ; CashICK#: :?)t 1 5 _- *, _—tl, ' t� 5 : ° Rcwd by _ i ,s3ri1e, u i,, { olruKI G IG)$ LA?` 1 Date Signed: 420 2 Signed: 5d C'Mr"i APPLICATION#: t ''5-.1S`S V5 2017 Bk 35082 Pg80 #22091 MASSACHUSETTS STATE EXCISE TAX 04-28-2022 @ 02 : 26p BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 04-28-2022 @ 02:26pm Ct1#: 763 Doc#: 22QV91.Q T N 0 T Fee: $2,479.50 Cons: $725,00u.00 BARNSTABLE COUNTY EXCISE TAX AN AN BARNSTABLE COUNTY REGISTRY OF DEEDS OFFICIAL 0 F F I C I ADate: 04-28-2022 @ 02:26pm Ctl#: 763 Doc#: 22091 COPY COPY Fee: $2,218.50 Cons: $725,000.00 NO QUITCLAIM DEED AN AN KNOW ALL MEti ffYFTAES3EIP) §ENTS thatVg,l '1�ER AI. eAIIPBELL and LAURIE A. CAMPBELL n/k/a £A'J11u1NYA. GOULET, being ucimmrrFeddof 51 Bray Farm Road South, Yarmouth Port, MA 02675, for consideration paid and in full consideration of Seven Hundred Twenty-Five Thousand and 00/100 Dollars($725,000.00), grant to PETER R. MATTILA and JOAN T.MATTILA,husband and wife, as tenants by the entirety,of 3 Pierce Avenue,Westford,MA 01886 0 b with QUITCLAIM COVENANTS ea The following property and land in Yarmouth Port, Barnstable County, Massachusetts, bounded and described as follows: Lot 8 shown on a plan entitled"PLAN OF LAND IN YARMOUTH, MASSACHUSETTS FOR FLENN HALEY, Scale 1"=40',May 7, 1986,R.J. O'HEARN, INC. SWAN RIVER PLAZA 35 Route 134,Unit 2,POST OFFICE BOX 237, SOUTH DENNIS,MASS. 02660"duly recorded in the Barnstable County Registry of Deeds in Plan Book 420 Page 79. U Parcel is subject to and has the benefit of those matters of record, including Common Driveway Agreement recorded with said Deeds at Book 31312,Page 99. We,Peter A.Campbell and Laurie A. Campbell n/k/a Laurie A.Goulet,the Grantors named herein do hereby voluntarily release all our rights of Homestead as set forth in M.G.L. Chapter 188, if any,and there are no other persons entitled to any such rights. For title see deed recorded in the Barnstable County Registry of Deeds in Book 13778,Page 327 1 Bk 35082 Pg81 #22091 NOT NOT AN N SIGNED under th®painwargl penaltivs Df perjury this R79i7k day bf t,if, , 2022. COPY COPY NOT plitvrivtNT AN OFF ICI AL peter .arppIlel10 I AL COPY COPY COMMONWEALTH OF MASSACHUSETTS Barnstable, ss On this 20a ." day of ► 1 , 2022,before me,the undersigned notary public, personally appeared Peter A. ampbell and proved to me through satisfactory evidence of identification,being(check whichever applies): river's license or other state or federal governmental document bearing a photograph ir'nage, o oath or affirmation of a credible witness known to me who knows the above signatory,or o my own personal knowledge of the identity of the signatory, to be the person whose name is signed above, and acknowledged to me that he signed the foregoing instrument voluntarily for its stated purpose and who swore or affirmed to me that the contents of this document are truthful and accurate to the best of his knowledge and belief. hubs' 'b-•' o�=nd,.w•rn r-fos- me ipNfuanfb - � •` o �, _: Notary Public • SLC 4r} t ' My commission expires: 2 Bk 35082 Pg82 #22091 NOT n j$A.iNT , ) SIGNED under the pains aad penalties of perjury this A day of e I , 2022. OFFICIAL OFFICIAL COPY cc P a /'NOT � , I. TA Ills AN Laurie A. Campbgl n/k/a Laurie A. Goulet OFFICIAL OFFICIAL COPY COPY COMMONWEALTH OF MASSACHUSETTS Barnstable,ss On this day of t ( ,2022, before me, the undersigned notarypublic, personally appeared Laurie . Campbell n/k/a Laurie A. Goulet and p ed to me through satisfactory evidence of identification, being(check whichever applies): driver's license or other state or federal governmental document bearing a photograph ima e. ❑ oath or affirmation of a credible witness known to me who knows the above signatory,or o my own personal knowledge of the identity of the signatory, to be the person whose name is signed above, and acknowledged to me that she signed the foregoing instrument voluntarily for its stated purpose and who swore or affirmed to me that the contents of this document are truthful and accurate to the best of her knowledge and belief. r Sub ibed sw0 c re me »��ti��,il„ ,,,,, .tip c,.\ y�lgalUVFttr i-• .'• t 'F otary Public— SEAL - \�\( Y -k4� co - My commission expires: //' (ti...r- c9f..7 , 3 JOHN F. MEADE, REGISTER BARNSTABLE COUNTY REGISTRY OF DEEDS RECEIVED & RECORDED ELECTRONICALLY ti4i5 JELDEN 30 in . x 80 in . 9 Lite Primed Steel Prehung Right-Hand Inswing Back Door w/Brickmoud (97) - --i-,4, . ,.. . .. - NA ",'':'"' ' ':1' •i S! ,V i, 'N.,'S.,')h'-' -' • ' iE7,1w,p'..,„-,-. ....--_;,,-„:`;'-' -‘1,''''' - :'- . ,,-- , ', ' gk's\--, ..,„17,, rQQ( i1.,10e,-„ ,h.../115),_ '•,..., . ;, :,2‘‘,, 4_ -+--zt -1 , , - .‘. '- ,,,,f,„,„. •' ,;,•',.•` :. - - -.4:-; ': • • ' 2,1 ,"' ';:::,::,,'"'-' ;•,. • 4 , k t o, # ,441' ' :IP '•2:4'-i ; ‘..t' ..ti,:l , lil i ''.1 ''''' ti - 11005 V - t' ..arotl'IL6_L-"Y 13veyrA / • ' .-6101.01.11, 11, , „:„„ ,,,e-- ' ,,,,,,,ri,,,,•,,,,, .‘ 1-1)1Z. 9 - 'z'.' -- -11"-, - ' -- If',e•';', \,.,- 1 t, -- ' . ',le, ' 00)r , '71,1INi ,, ' ---voe(I ' , , ,. ....----- ....n...7„p 0 ....„.„---- ...'-'"', i - , .. I ree-34/ , .: •. , vi.,31 44n oNill,.: .11,23 tk :31Va A NVIldN°3 nliddV i v\jo-dj iNV--.__,,\, -..„,-. ,rival9NOdS121,„2,H, ,,-,!,- - v--1 y 7 q ji di1119 S:ls, -,)- — - .r' '''" '6--1—- - - - 4114:; 1, ..414 i ei I Litj (::, lc I , . e 41. ,... ..., , ...,,,,,, ,,„.„, , ko *"t""t'"'Vtt:''"F"^"'';'"°'P,A M'' .,.**.WW.,,,,A*14"47,, ,,,,,Otam0$14,4,,,,, .11.,..”1" q. <100.1 lc T. $,/ ,, 4„44 4 , 4, #v :...R4 % ✓no,iTAPr, 'sa e_. . -''', zij .N...,,,,,,,.. 4) 4111, I r lik."%nt 1 e, a tit 4 _otifiwitallawifiswidamdflimifilalfaawle i ..... «a•;r,.zwn & 40 qr:3 a,� "4, x �n�,,�• �i aW aar�staxr '�# - w , ' "•,, €, = 1.,* 1 Z , r z �,�w:..: - �waaw ,�r't-- :,��w.a•««rm.._ .� �•:a�..«aa'� -.<�u .,ra,-w.r,�,� «,,.a�.. ,w.«,«. ...�.�.:s. - of •